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Ellen Josephine Handoko
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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USG Guided Interscalene Nerve Block as Perioperative Management in Close Fracture Clavicula with Traumatic Brain Injury Patient and Contusio Pulmonum: A Case Report Prasetya, Novandi Lisyam; Muhammad Husni Thamrin; Ellen Josephine Handoko
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.582

Abstract

Introduction: Blunt trauma from motor vehicle accidents (MVA) often results in multisystem injuries, including chest, head, and musculoskeletal injuries. Management of these complex injuries requires a multidisciplinary approach and can present unique anesthetic challenges. Case presentation: A 22-year-old man was treated in the emergency department (ER) after experiencing an MVA. The patient experienced chest and shoulder pain and was found to have anemia, increased creatinine, respiratory acidosis, prolonged prothrombin time (PT), and increased serum glutamic oxaloacetic transaminase (SGOT). Radiological examination revealed left tension hydropneumothorax, right hydropneumothorax, bilateral lung contusions, fractures of the ribs, clavicle, and scapula. In addition, the patient also experienced subarachnoid hemorrhage (SAH) in the left parietotemporal region and right cistern (Fisher Scale III), brain edema, right pneumo-orbita, type III septal deviation, bilateral inferior nasal concha hypertrophy, and concha bullosa on the medial nasal concha. The patient's physical status was assessed as ASA III. The patient underwent open reduction and internal fixation (ORIF) with an S-plate on the right clavicle. Anesthesia was provided with an interscalene block using 0.375% levobupivacaine and premedication with Fentanyl and Midazolam. Conclusion: This case highlights the complexity of managing blunt trauma patients with multisystem injuries. A multidisciplinary approach, including careful airway management, hemodynamic monitoring, and selection of appropriate anesthetic techniques, is essential for optimal results.
Acute Motor Axonal Neuropathy with Respiratory Failure: A Case Report on the Clinical Course Following a Single Session of Therapeutic Plasma Exchange Wirjapratama Putra; Septian Adi Permana; Ellen Josephine Handoko
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.775

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Introduction: Guillain-Barré syndrome (GBS) is a severe, immune-mediated peripheral neuropathy. The acute motor axonal neuropathy (AMAN) variant, characterized by a direct antibody attack on motor axons, often leads to rapid, severe paralysis. Standard immunotherapy for severe GBS involves a multi-session course of therapeutic plasma exchange (TPE) or Intravenous Immunoglobulin (IVIg). Case presentation: We present the case of a 68-year-old male with rapidly progressive GBS, confirmed as the AMAN subtype through clinical, cerebrospinal, and electrophysiological findings. The patient developed flaccid quadriparesis and acute respiratory failure, necessitating emergent intubation and mechanical ventilation in the intensive care unit (ICU). Following a single, large-volume session of TPE, a marked and rapid clinical improvement was observed. The patient was successfully weaned from mechanical ventilation and transferred from the ICU within three days of the intervention. Conclusion: This case documents a noteworthy temporal association between a single TPE session and rapid clinical recovery in a patient with ventilator-dependent AMAN-GBS. While a causal relationship cannot be definitively established due to the disease's natural history, the observation prompts a deep exploration of the underlying pathophysiology. The discussion theorizes how a single, well-timed intervention might profoundly disrupt the autoimmune cascade by affecting peak antibody titers, complement activation, and cytokine kinetics.
Co-Authors Muhammad Husni Thamrin Prasetya, Novandi Lisyam Septian Adi Permana Wirjapratama Putra